Systemic adverse reactions may be observed. Although rarely occurring in very short term therapy, they should always be carefully traced. This is part of the follow-up of any corticotherapy, and does not specifically pertain to any particular product. These possible adverse reactions of glucocorticoids like methylprednisolone are: These possible adverse reactions of glucocorticoids like methylprednisolone are: INTRAMUSCULAR: Fluid and electrolyte disturbances: In comparison with cortisone or hydrocortisone, mineralocorticoid effects are less likely to occur with synthetic derivatives as methylprednisolone acetate. Sodium retention; Fluid retention; Congestive heart failure in susceptible patients; Potassium loss; Hypokalemic alkalosis; Hypertension.
Musculoskeletal: Muscle weakness; Steroid myopathy; Osteoporosis; Vertebral compression fractures; Aseptic necrosis; Pathologic fracture.
Gastrointestinal: Peptic ulceration with possible perforation and hemorrhage; Gastric hemorrhage; Pancreatitis; Esophagitis; Perforation of the bowel.
A temporary and moderate increase in the SGOT, SGPT values and the alkaline phosphatase can occur; but it is not associated with any clinical symptom.
Dermatologic: Impaired wound healing; Thin fragile skin; Petechiae and ecchymoses.
Neurological: Increased intracranial pressure; Pseudotumor cerebri; Seizures; Psychic derangements may appear when glucocorticoids are used ranging from euphoria, insomnia, mood swings, personality changes and severe depression to frank psychotic manifestations; Vertigo.
Endocrine: Menstrual irregularities; Development of Cushingoid state; Suppression of growth in children; Suppression of pituitary-adrenal axis; Decreased carbohydrate tolerance; Manifestations of latent diabetes mellitus; Increased requirements for insulin or oral hypoglycemic agents in diabetics.
Ophthalmic: Prolonged use of glucocorticoids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves and may enhance the establishment of secondary ocular infections due to fungi or viruses.
Glucocorticoids should be used cautiously in patients with ocular herpes simplex for fear of corneal perforation.
Increased intra-ocular pressure; Exophthalmos.
Metabolic: Negative nitrogen balance due to protein catabolism.
Immune system: Masking of infections; Latent infections becoming active; Opportunistic infections; Hypersensitivity reactions including anaphylaxis; May suppress reactions to skin tests.
IN SITU ADMINISTRATION: Because of the resorption from the place of administration into the systemic circulation, sufficient attention is recommended for the above-mentioned systemic adverse reactions.
In addition in situ administration can cause dermal and subdermal atrophy. While crystals of corticosteroids in the dermis suppress inflammatory reactions, their presence may cause disintegration of the cellular elements and physiochemical changes in the ground substance of the connective tissue. The resultant infrequently occurring dermal and/or subdermal changes may form depressions in the skin at the injection site. The degree to which this reaction occurs will vary with the amount of corticosteroids injected. Regeneration is usually complete within a few months or after all crystals of the corticosteroid have been absorbed.
THE FOLLOWING ADDITIONAL REACTIONS ARE RELATED TO PARENTERAL CORTICOSTEROID THERAPY: Rare instances of blindness associated with intralesional therapy around the face and head Anaphylactic or allergic reactions; Hyperpigmentation or hypopigmentation; Subcutaneous and cutaneous atrophy; Sterile abscess; Postinjection flare, following intra-synovial use; Charcot-like arthropathy; Injection site infections following non sterile technique.
ADVERSE REACTIONS REPORTED WITH SOME NON RECOMMENDED ROUTES OF ADMINISTRATION: Intrathecal/epidural: Arachnoiditis, meningitis, paraparesis/paraplegia, sensory disturbances, bowel/bladder dysfunction, headache, seizures.
Intranasal: Temporary or permanent visual impairment including blindness; allergic reactions; rhinitis.
Ophthalmic: Temporary or permanent visual impairment including blindness, increased intra-ocular pressure, ocular and peri-ocular inflammation including allergic reactions, infections, residue or slough at injection site.
Miscellaneous injection sites (scalp, tonsillar fauces, sphenopalatine ganglion): blindness.